Participation of pre-hospital emergency physicians at ambulance missions in Germany's federal states

PurposeThis study aims to determine the differences in the involvement of pre-hospital emergency physicians (PHEPs) within the ambulance service over time and between the federal states and identify possible reasons for the differences.Design/methodology/approachThe federal state-specific PHEP rates from 2012 to 2017 were analysed using publicly available data or data provided by the responsible state ministries. In addition, various correlations between PHEP rates and sociodemographic and health data were calculated.FindingsThe PHEP rates differ significantly between the 16 federal states. In 2017, Schleswig–Holstein had a PHEP participation rate of 19.00%, while in Mecklenburg-Western Pomerania the rate was 41.08%. In all surveyed states, the rate fell over time. Only in Mecklenburg-Western Pomerania, the rate increased from 37.68% in 2012 to 41.08% in 2017 (OR: 1.15 [95% CI: 1.14; 1.17]). Federal state-specific PHEP rates indicated strong deviations from the overall PHEP rate of all included federal states with ORs ranging from 0.61 (95% CI: 0,61; 0,62) for Schleswig–Holstein to 1.82 (95% CI: 1.81; 1.84) for Mecklenburg-Western Pomerania. Socioeconomic factors indicated (inverse) correlations with the federal state-specific PHEP rate.Originality/valueThe PHEP rates differ significantly between the federal states. The correlations indicate possible connections but do not show clear causes within state-specific characteristics. Consequently, the occupational autonomy of paramedics differs between the states.